Provider Demographics
NPI:1992198261
Name:TRANSITIONS BODYWORK CLINIC INC.
Entity Type:Organization
Organization Name:TRANSITIONS BODYWORK CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAD
Authorized Official - Middle Name:DORSEY
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:719-242-7263
Mailing Address - Street 1:2310 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-4801
Mailing Address - Country:US
Mailing Address - Phone:719-242-7263
Mailing Address - Fax:
Practice Address - Street 1:2310 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-4801
Practice Address - Country:US
Practice Address - Phone:719-242-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0006794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty